Early Hematoma Evacuation Can Prevent Infectious Complications in Patients with Spontaneous Intracerebral Hemorrhage

Background/Objectives: Infections are common complications in patients with spontaneous intracerebral hemorrhage (ICH). This study investigated whether early surgical hematoma evacuation can reduce post-ICH infections and the impact of residual hematomas on infectious complications. Methods: Demographic, radiological, and clinical outcome data were collected for 174 patients with spontaneous ICH. The patients were classified according to treatment (Group A, without surgery; Group B, hematoma evacuation with residual hematoma volume ≥10 mL; Group C, hematoma evacuation with residual hematoma volume <10 mL). Kaplan-Meier analysis was used to evaluate infectious complications following ICH, while multivariate logistic regression analysis was used to identify risk factors for infectious complications. Results: Groups A, B, and C included 88 (50.6%), 25 (14.4%), and 61 (35.0%) patients, respectively. A total of 68 patients (39.0%) experienced 88 infectious complications, most frequently pneumonia and urinary tract infections. Group C had a significantly lower frequency of infectious complications compared with Groups A and B (p = 0.016). The independent risk factors for infectious complications included age, higher National Institutes of Health Stroke Scale score at admission, motor weakness, intraventricular hemorrhage, Group A, and Group B. Patients with infections had longer hospital stays. The frequencies of poor clinical outcomes at one and six months in patients with infection were lower than those in patients without infection (both p < 0.01). Conclusions: Surgical hematoma evacuation can reduce the risk of post-hemorrhagic stroke infections. Moreover, residual hematoma after surgical evacuation was associated with the risk of cytotoxic effects and subsequent infectious complications.